The most frequently asked question is about how the changes from the Affordable Care Act (ACA) will affect Medicare benefits. The fact is that healthcare reform is not cutting benefits to people with Medicare to pay for the program. The law actually protects Medicare’s basic (Part A and Part B) benefits and improves coverage for many. The savings being drawn from the Medicare program over the next several years will come from: reducing fraud, keeping people healthier, and providing care that is better coordinated, like improving the communication among your healthcare providers and covering better follow-up care when you leave the hospital so you don’t go right back in (now, one in five people who are discharged are re-admitted to the hospital within 30 days.)
Some of the savings will also come from changes to how the federal government will pay Medicare Advantage plans starting in 2012. These plans, which are run by private companies paid by the government to provide Medicare benefits to members, may decide to make some changes, but they will still be required to provide all the Medicare Part A and Part B benefits you get now.
There are also significant positive changes for people on Medicare that start this year, including:
- New coverage of preventive healthcare services at no cost to you. As of January 1, 2011, deductibles and co-pays are eliminated for many Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force These services include, for example, important tests like mammograms and colorectal cancer screening .
- The ACA authorizes Medicare to pay for an annual wellness visit to your doctor – including a physical exam, tests and a personalized prevention plan (a schedule of screenings and health promotion activities) to help keep you healthy.
- The ACA is also beginning to slowly close the Medicare Part D "donut hole," the coverage gap people with a Part D insurance plan reach after they have used prescription drugs that cost a certain amount ($2,840 in 2011). During the donut hole, you continue to pay your plan premiums, but until this year, you have been responsible for the total cost of your drugs until you reach another cost level ($6440 in 2011). To help cover the costs last year, the federal government issued a $250 check to each person who fell into the donut hole in 2010; 130,426 Medicare recipients in Illinois received a check. Beginning January 2011, there will be no more checks. Instead, everyone who hits the donut hole will get a 50% discount on brand name drugs and 7% discount on generics. Over the next nine years, people in the donut hole will continue to get a 50% discount on brand names and higher generic discounts each year until there is no gap by 2019. Also, the Illinois Cares Rx pharmaceutical assistance program in Illinois will still be available in 2011 to help cover the costs of prescription medications for low income older adults and people with disabilities.
For older adults who are not eligible for Medicare, there is also some new help from the ACA. The group of people aged 55-64 have been especially hard hit by the economic downturn (layoffs, extended unemployment, early retirement) and have the hardest time finding private insurance. There are about 287,000 uninsured adults in Illinois in this pre-Medicare population. Under the ACA, the state is providing a new health plan for people under 65 with pre-existing conditions that have had no insurance coverage for 6 months—called IPXP (Illinois Pre Existing Condition Plan). The IPXP program is funded by the federal government and is less expensive than the current high risk pool, ICHIP.
The ACA also provides tax incentives and help paying claims to encourage businesses to continue to offer coverage to employees and former employees in this age group. The Alliance for Health Reform and AARP, answered many questions about ACA provisions of interests to 50-64 year olds in a briefing last week, which can be found here.
For more information on Medicare, health care reform implementation, and Illinois Cares Rx, please contact AgeOptions at: http://www.ageoptions.org/ or 1-800-699-1043.
AgeOptions, Director of Benefits & Advocacy and Director, Make Medicare Work Coalition
AgeOptions, the Area Agency on Aging of suburban Cook County, is designated by the Illinois Department on Aging to plan, fund and coordinate services and advocate for the more than 460,000 older adults and their families in the 130 communities in the suburban Chicago area. AgeOptions also co-leads the Make Medicare Work Coalition (MMW) in partnership with Health & Disability Advocates and Progress Center for Independent Living, providing education and policy advocacy for older adults and people with disabilities in Illinois about healthcare options. The coalition is made up of members from more than 250 organizations, including government agencies, healthcare and social service providers and a variety of community based agencies.